Temporary Location Request

Please answer all questions.  

1)  Name of Dealership:

2)  Address of Dealership:

Mailing Address:






Zip Code:

3)  Dealer Number:

4)  Dealership Telephone Number (999) 999-9999:

5)  Dealership Fax Number (999) 999-9999:

6)  Dates of Off Premise Display/Sale:
 From:  To: 

7)  Location of Display/Sale:
(Name of facility, Street Address, City and Zip Code are required for the location of the off premise display/sale.)

Name of Facility:


Street Address:




Zip Code:

Use Comments or Description to explain nature of display/sale.

Comments or Description of Display/Sale:

8)  Your Email Address (Certificate Will Be Sent to This Address):
When you submit this form, the information will be transmitted to the DMV, and you will be taken to a page that you may print for your records only. 

The OFFICIAL PERMIT will be emailed to you once it is approved.


To validate this request, please answer the following question:

7 plus 9 =


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